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Clinical Paper| Volume 85, ISSUE 12, P1686-1691, December 2014

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HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): A randomised controlled feasibility trial

  • Paul Young
    Correspondence
    Corresponding author at: Intensive Care Unit, Wellington Regional Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand.
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand
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  • Mark Bailey
    Affiliations
    Wellington Free Ambulance, PO Box 601, Wellington, New Zealand
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  • Rinaldo Bellomo
    Affiliations
    Intensive Care Unit, Austin Hospital, PO Box 5555, Heidelberg, 3084 Victoria, Australia

    Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia
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  • Stephen Bernard
    Affiliations
    Alfred Hospital, 55 Commercial Road, Melbourne, 3004 Victoria, Australia
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  • Bridget Dicker
    Affiliations
    St John Ambulance, 2 Harrison Road, Private Bag 14902, Panmure, Auckland, New Zealand
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  • Ross Freebairn
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Hawke's Bay Hospital, Omahu Road, Private Bag 9014, Hastings, New Zealand

    Chinese University of Hong Kong, Sha Tin, Hong Kong, China
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  • Seton Henderson
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Christchurch Hospital, 2 Riccarton Avenue, Christchurch, New Zealand
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  • Diane Mackle
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand
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  • Colin McArthur
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia

    Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
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  • Shay McGuinness
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia

    Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
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  • Tony Smith
    Affiliations
    St John Ambulance, 2 Harrison Road, Private Bag 14902, Panmure, Auckland, New Zealand

    Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
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  • Andrew Swain
    Affiliations
    Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand

    Wellington Free Ambulance, PO Box 601, Wellington, New Zealand
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  • Mark Weatherall
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand

    University of Otago, School of Medicine, PO Box 7343, Wellington South, Wellington, New Zealand
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  • Richard Beasley
    Affiliations
    Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand

    Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand
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      Abstract

      Aims

      To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT).

      Methods

      We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period.

      Results

      159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3%; 95% CI 1.0–20.5%). Low measured oxygen saturation (SpO2 < 88%) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P = 0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible.

      Conclusions

      Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.

      Keywords

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